Tobacco Harm Reduction: A Lesson from Public Health

1. THE U.S. EXPERIENCE WITH TOBACCO HARM REDUCTION

2. My name is Gregory Conley Smoked for eight years – quit in August 2010 Pro Bono Legislative Director – CASAA President – American Vaping Association

3. HARM REDUCTION What can we learn from the public health experience with harm reduction?

6. PROMOTING USE OF CONDOMS Wider environment and access: limited restrictions on where and to whom condoms can be sold, promotion of products about sex not about disease, policy approach which destigmatises use. Reach is wide and to all people who might have or are having sex

7. NICOTINE The second most used drug in the world If smokers can’t or won’t quit, what’s the ethical thing to do?

8. People smoke for the nicotine but they die from the tar. • Dr. Michael Russell , British Medical Jorunal, 1976

9. IS NICOTINE 100% SAFE? Probably not: May cause adverse effects in pregnancy & those with heart conditions. Can cause dependence. BUT no contribution to lung disease, cancer, or heart disease in long-term NRT or snus users. Nicotine also has positive effects – Concentration, lowers BMI, may prevent Parkinson's disease and ulcerative colitis. Must be compared against smoking – not no use at all WE DON’T LIVE IN A PERFECT WORLD

10. 40 YEARS LATER Public health got ‘harm reduction’ right with drugs / sex, but continues to get it wrong with tobacco and nicotine ‘Harm elimination’ strategy is puritan in nature & ignores reality of smoking

11. “HARM ELIMINATION” POLICIES HAVE FAILED Public health agencies have pushed nicotine replacement therapy (NRT) products for two decades In the real world: 3% - 9% success rate (terrible!)

12. THE TOBACCO HARM REDUCTION PROPOSITION Smokers risk disease and premature death Most smokers say they want to stop. Many are unwilling or unable – they like it Smoking is the most harmful way to get nicotine

13. TOBACCO HARM REDUCTION AND HUMAN RIGHTS WHO Constitution (1946): “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…” Providing safer ways to deliver nicotine recognizes human choice, while also dramatically lowering health risks.

14. PROOF OF CONCEPT – SNUS IN SWEDEN

15. SNUS IS MUCH SAFER

16. HIGH SNUS RATES, BUT LOW DISEASE RATES

17. RISK PERCEPTIONS IN AMERICA ARE OFF In a study of 256 smokers • ~45% perceived snus to be as harmful as smoking overall and for all three risks: lung cancer, heart disease and oral cancer. • ~40% incorrectly perceived the risk of oral cancer to be higher from snus use than smoking. - Why would they switch?

18. VAPING The first viable harm reduction solution for the US population

19. WHAT ARE VAPOR PRODUCTS? Battery operated Tobacco-free, combustion-free, can be nicotine-free After user inhales, battery supplies small amount of heat to atomizer, which converts liquid into a vapor Many different kinds

20. Some people may mistakenly perceive these products to be safer alternatives to conventional tobacco use • Rita Chappelle (FDA Spokesperson), NPR, 2009

21. U.S. PUBLIC HEALTH AGENCIES DECLARE WAR ON VAPING 2009 – major public health groups urge FDA to declare e-cigarettes to be “drugs.” FDA agreed. Spent two years seizing shipments of e-cigarettes at the border. Deadly cigarettes remained legal. FDA eventually lost in court. But the battle had only just begun

22. ‘PUBLIC HEALTH’ IGNORES THE EVIDENCE

23. ‘PUBLIC HEALTH’ LOSES ITS WAY

24. METALS Aluminum – daily exposure >800 times below safety limit

25. MORE FALSE SCARES & MISINFORMATION FORMALDEHYDE Aldehydes are created by overheating EC liquid. ‘Dry puffs’ are acrid and nasty. Humans recognize this and modify their vaping, but machines do not. Much the same with acetone POPCORN LUNG Exposure to very high doses of diacetyl among popcorn plant workers causes lung disease But levels in EC vapor are 100-750 times lower than in cigarette smoke. Another agenda-driven scare

26. ANIMAL & CELL STUDIES Generate a lot of alarmist headlines, but scientifically suspect Does the study actually replicate human behavior? Does the study compare smoking to vaping? No single cell or animal study can tell us anything – needs a lot of follow-up

27. RECENT “VAPING-RELATED” ILLNESSES & DEATHS Recent illnesses and deaths in America are primarily or exclusively caused by contaminated marijuana products. Number of Americans accurately believing vaping to be less hazardous than smoking has plummeted.

28. THE MESSAGE BEING SENT TO SMOKERS

29. THE GOOD NEWS Adult & youth smoking is plummeting and more public health orgs are learning the truth about vaping

30. OUTSIDE THE U.S. – PUBLIC HEALTH PUSHES BACK

31. Large-scale substitution of e-cigarettes, or other non-tobacco nicotine products, for tobacco smoking has the potential to prevent almost all the harm from smoking in society • Royal College of Physicians, 2016

32. RESPONSIBLE PUBLIC HEALTH MESSAGE IN THE UK

33. THE GOOD NEWS – MANY SMOKERS ARE IGNORING WARNINGS 2016 survey estimated that at least 2.6 million smokers credit vaping with helping them quit smoking. Even more today. Another 2014 survey found that ~22% of smokers who quit in the last year are vaping

34. WHAT ABOUT YOUTH?

36. SUPPORT THE NEW NICOTINE MARKET

37. FIGHT FOR SMOKE-FREE LIVES

38. Vaping.org Questions?